The International Migration of Nurses in Long-Term Care

This article describes five major factors that are affecting patterns of international migration among nurses who work in long-term care settings:

• Demographic drivers–The aging of the populations in developed countries and the low to negative growth in the working-age population will increase the demand for international workers to provide long-term care services.

• Gender and race–A dual labor market of long-term care workers, increasingly made up of women of color, is becoming internationalized by the employment of migrating nurses from developing countries.

• Credentialing–The process of credentialing skilled workers creates barriers to entry for migrating nurses and leads to “decredentialing” where registered nurses work as licensed practical nurses or aides.

• Colonial history and geography–The colonial histories of many European countries and the United States have increased migration from former colonies in developing countries to former colonial powers.

• Worker recruitment–Efforts to limit the recruitment of health care workers from some developing countries have had little effect on migration, in part because much of the recruitment comes through informal channels of family and friends.

     

Staffing-Related Deficiency Citations in Nursing Homes

There is evidence that staffing characteristics influence quality of care in nursing homes. Federal and state surveyors conduct inspections of homes to assess their compliance with regulatory standards, including requirements related to staffing. Deficiency citations are issued when these standards are not met. This article examines the relationship between operational, facility, and market characteristics and organizational performance measured as staffing-related deficiency citations. Online Survey Certification of Automated Records (OSCAR) data from 2000 through 2007 were used with multinomial logistic regression analyses to identify factors associated with deficiency citations for staffing. Chain members and facilities with poor quality of care were more likely to receive deficiency citations for staffing. Greater bed count and competition between nursing homes were associated with a decreased likelihood of deficiency citations for staffing. Staffing-related deficiencies within nursing homes vary according to various operational, facility, and market characteristics.     

The Nursing Home Compare Report Card: Consumers' Use and Understanding

The Nursing Home Compare report card provides information on the World Wide Web about quality measures for almost every nursing home in the United States. In this research, we first examined whether consumers were using Nursing Home Compare. Second, we examined whether consumers could accurately interpret the quality information given in Nursing Home Compare. Data were collected from 4754 family members of nursing home residents. A comprehension index was used to examine whether the information contained in Nursing Home Compare for each quality measure was understood by family members. We found that 31% of these consumers used the Internet in choosing a nursing home, and 12% recalled using Nursing Home Compare. We also found that, in general, the comprehension index scores were high, indicating good understanding. Simply having the Nursing Home Compare report card available does not mean that it will be used, nor does it mean that it can influence consumers in any meaningful way. The findings show that consumers understand Nursing Home Compare information, and approximately 12% currently access the Web site.     

A Medicare Adult Day Care Model

The study on which this article is based addressed the issue of the proportion of adult day care centers (ADCs) existing in 1986 that would qualify for Medicare funding under the 1989 U.S. Senate Medicare Adult Day Care Amendments. It also estimated the impact of the criteria on two policy-relevant subgroups of ADCs-that is, Alzheimer's vs. non-Alzheimer's and rural vs. urban-using data from a 1986 national census survey of ADCs. The five proposed Medicare criteria and the percentage of ADCs meeting hem were: services to be provided directly, 14.6%; multidisciplinary team, 20%; services to be provided directly or indirectly, 16%; program activities, 42%; and other, 53%. Only 3% met all five criteria while 13% met four out of five. Alzheimer's centers met the criteria more often than non-Alzheimer's centers, while urban centers qualified more often than rural centers. Based on the findings. implications for Medicare funding policy are discussed.     

Conforming to and Resisting Dominant Gender Norms: How Male and Female Nursing Students Do and Undo Gender

Much existing research has shown that men are able to construct and enact masculine identities in female‐dominated occupational contexts. However, few studies have examined the experiences of both men and women in these occupations. Furthermore, few studies attend to how men and women in these occupations both conform to and resist gender norms. In this study, I draw on the undoing gender frameworks developed by Deutsch and Butler to address the limitations mentioned above. Most notably, this study attends to the ways in which male and female nursing students do gender by conforming to dominant gender norms, as well as undo gender by resisting these norms. The main contribution of this study is thus to show the multiple ways through which gender can be done and undone in the professional training of both male and female nurses. The results of this study demonstrate the importance of attending to both women and men in research on female‐dominated occupations and of examining both similarities and differences in the gender performances of men and women.     

A Stain on the White Uniform — The Discursive Construction of Nurses' Industrial Action in the Media

This article focuses on the discursive construction of the nursing profession in the context of an industrial action. Drawing on studies that claim that the diffusion of new public management reforms restructure healthcare professions and on feminist studies arguing that gender is crucial to understanding the concepts and processes of this restructuring, the article examines a media debate surrounding a recent labour dispute in the Finnish healthcare sector. The analysis illustrates how the nursing profession was discursively constructed through a negotiation of individual and societal rights and responsibilities, and how the debate was framed by competing and contested discourses of professionalization, caring, labour markets and new public management. As a consequence, the debate both sustained and reproduced the traditional gendered meanings related to the nursing profession, as well as provided a context for unsettling, at least for a moment, the normative gender order of Finnish society.     

Understanding Nurse Perceptions of a Newly Implemented Electronic Medical Record System

Nurses are the frontline of healthcare; however, there has been little theoretically-driven research on their acceptance of information technology use in care delivery. This research utilized the unified theory of acceptance and use of technology (UTAUT) model to understand how hospital nurses perceived the implementation of a new electronic medical record (EMR) system. This study used mix methods. The survey responses indicated that social influence and performance expectancy were significant factors in system adoption. Effort expectancy did not have a significant influence on the intention to use the EMR. The interviews were utilized to better understand these results. The UTAUT model highlighted factors that are important to nurses during an EMR deployment and can help in future implementations of technology in healthcare.     

Transformative Homes

ABSTRACT

In the era of global workflows and massive migrations, it has been suggested that the notion of home is breaking free from its material aspects to become a set of exportable routines and practices. On the other hand, it is argued that the materiality of spaces and objects can support migrants' well-being in the new destination. Drawing on the ethnography of a Moroccan household in Rome, Italy, we illustrate how actions pertinent to the material home can favor identity development and the exercise of agency. First, we discuss squatting as a collective action of appropriation and transformation, which led to the identification with a transnational, intercultural category of migrant. Second, we illustrate the activities of furnishing as the locus of syncretic and reflexive processes, in which elements of the host country and themes from the migratory experience are mixed and reinterpreted in novel ways. Our analysis supports the view that the materiality of the home and the actions it affords play a major role in the socio-psychological adjustment of migrants and—on a wider scale—in processes of cultural dynamism and renovation.     

Demographic Characteristics

This article aims to describe the characteristics of and design elements in gardens/patios at 87 residential living homes for older people and to describe and compare residents’ and staff members’ perceptions of outdoor spaces. The aim was also to investigate factors related to residents' satisfaction with and stays in the garden/patio. The result showed that many gardens/patios had several recommended design elements and, at the same time, obvious deficiencies. The residents (n = 415) valued various aspects of the garden/patio more highly than did the staff (n = 667). Managers responsible for residential living homes for elderly people should take measures to ameliorate deficiencies and deficient elements in design and accessibility that are lacking so that the garden/patio can be used as an important health promotion resource in the care of elderly people. Residents and staff are important actors in such development work.     

“Would You Do That in Your Home?” Making Nursing Homes Home-like in Culture Change Implementation

Qualitative interviews with nursing home administrators reveal innovative and cost-conscious ways to physically modify facilities that help institute culture change practices. Telephone interviews were conducted following a national survey of nursing home nursing directors and administrators. In this cross-sectional snapshot of administrator experiences, motivations for making facilities more home-like and less institutional and creative responses to challenges are described. State and corporate support and regulator encouragement are noted that help their reform efforts. Administrators note that small steps to create a more home-like environment can result in a positive impact that minimizes disruption to existing care processes. They describe how they respond to challenges, such as the physical plant and high costs, and note how comparative shopping, cost-conscious physical improvements, and continuous involvement of staff and residents contribute to successful efforts. Their examples illustrate novel ways to humanize long-term care facilities that other nursing homes can emulate.